SA - Intro, Tumors, Chemo, Paraneoplastic, Hemangio

What are the 3 steps of carcinogenesis?

initiation, promotion, progression

What two types of genes does the elephant have in excess that allows them to fight off cancer??

p53 and LIF6

tumorigneesis begins with an ____ mutation in the epithelial cell

oncogene

tumor grading is determined _____

histopathologically

T/F histopathology of a tumor can be predictive of its behavior

true

What is tumor staging?

Where in the body the tumor is located

What does TNM stand for in tumor staging?

tumor, lymph node status, metastasis beyond local lymph node

What are the rules of oncology?

Know WHAT to treat, BIOLOGY of tumor, WHERE on the body, APPROACH planned out, know LIMITATIONS, EDUCATE client, ASK

What is another term for marginal excision?

excisional biopsy

How do you define an excisional biopsy?

<1cm margin to take out tumor and pseudocapsule, ± removal of facia

wide excision is defined as ____

2-3cm margin, 1 uninvolved fascial plane

Are follicular cysts and sebaceous gland adenomas benign or malignant? how would you remove?

benign, marginal excision

How would you excise a lipoma and why?

incise over the center, fish out with capsule in tact, they are benign

What is the main location of intramuscular lipomas and what consideration should be taken

thigh, sciatic nerve

You see a tumor on CT with linear striations. What is this?

infiltrative lipoma

How do you approach removal of an infiltrative lipoma?

treat like malignant skin mass, wide margins

T/F liposarcomas arise from malignant standard lipomas

false. Treat them with wide resection

Do you take mast cell tumors to surgery?

depends on grade (appearance, location, hx)

What is the best course of action if margins of a MCT cannot be obtained?

neoadjuvant therapies

What are the options of neoadjuvant therapies with MCT?

prednisone, radiation, chemo

What do you remove with grade 1-2 MCT?

2cm lateral, 1 uninvolved plane deep

What does proportional margin mean?

margin equal to widest diameter of tumor?

How do you remove an MCT grade 3 tumor?

3cm laterally, 1 uninvolved fascial plane deep

How do you treat a subcutaneous MCT?

like a low grade MCT

T/F some forms of MCT regress naturally in cats

true

You have a cat with a small bump on its head. What is this most likely?

feline cutaneous MCTs

where are soft tissue sarcomas most common?

limbs and trunks

What do soft tissue sarcomas feel like?

firm and fixed

Do you remove soft tissue sarcomas with wide or marginal removal?

wide

What are the options for a soft tissue sarcoma on a limb?

neoadjuvant therapy of some sort, aputation maybe?, marginal excision and hope that its low grade

What are the proper steps for felinen injxn site sarcomas?

very locally aggressive, refer is a must for imaging, 5cm lateral removal + 2 uninvolved planes

Do dogs or cats have greater chance of malignant mammary tumors?

cats

define lumpectomy

removal of mammary mass with 1cm margin

describe single mastectomy

removal of single gland, with 1-2 cm margin

regional mastectomy

removal of glands 1-3 or 3-5

describe unilateral mastectomy

removal of mammary chain

T/F fascia needs to be removed with mammary tumors

false

bilateral chain mastectomies are suggested in which breed?

cats

What is the MOA of purine and pyrimidine antagonists?

stops the AA from forming RNA into DNA

What is the MOA of Cytarabine?

inhibits DNA elongation

What is the MOA of Alkylating agents?

cross link the DNA preveniting transcription and translation

Cisplatin, Chlorambucil, Cyclophosphamide, and L-asparaginase are examples of what type of chemo?

non cell cycle specific

What is AUC?

area under the curve

What is Cmax?

highest concentration of drug in blood

What is the therapeutic index?

ratio of toxic dose and therapeutic dose

What is M2?

body surface area

Cytotoxic chemotherapy works really well with what type of tumors?

round cell tumors

define cytostatic chemotherapy

disrupting cell replication, keeps tumors the same size.

define metronomic chemo

anti-angiogenic, small doses regularly

What is the fractional cell kill hypothesis?

give the highest tolerated dose at the shortest frequency tolerated

Chemo drugs follow first order kinetics. Whta does this eman?

they consistently kill a given proportion or cells and not a given number

define primary induction therapy

first and only treatmentdefine

define primary neoadjucant chemo

first treatment before other modalities

define adjuvant chemo

treatment with other modalities

define metronomic chemo

low doses of chemo at regular intervals

define vesicant chemo

when leaked into a vein causes blistering and necrosis

alkylating agents are most commonly used for ___ tumors

round cell tumors

What type of chemo is Melphalan?

alkylating agent

Melphalan is primarily used for ____

multiple myelomas (relapsed lymphomas)

How is melphalan administered?

orally, daily

What is the toxicity risk with melphalan?

myelosuppression (neutropenia, thrombocytopenia)

What type of chemo is cyclophosphamide?

alkylating agent

What is Cyclophosphamide used for?

multidrug protocols for lymphoma

How is cyclophosphamide administered?

oral or IV

What is the toxicity risk for cyclophosphamide?

neutropenia, sterile hemorrhagic cystitis

What type of chemo is ifosfamide?

alkylating agent

What is the primary use of ifosfamide?

high grade metastatic relapsed sarcoma

How is ifosfamide administered?

IV, with fluid diuresis, must be with MESENA

What are the toxicity risks of ifosfamide?

myelosuppression, nephrotoxicity, bladder damage

What type of chemo is lomustine?

alkylating agent

What is the primary use for lomustine?

histiocytic sarcoma, cutaneous LSA, MCT

What are the administration concerns with lomustine?

CBC and liver panel before to make sure liver is healthy, given orally

What is the important toxicity risk with lomustine?

hepatotoxicity in dogs

What kind of chemo is doxorubicin?

antitumor antibiotics

Whta is the toxicity risk of doxorubicin?

cardiotoxicity, nephrotoxicity in cats

What is an antitumor antibiotic that works as an alternative for doxorubicin in heart disease patients?

mitoxantrone

What type of chemo is cystosine arabinoside?

antimetabolites

What are the toxicity risks of antimetabolites?>

myelosuppression

What kind of chemo is 5-flourouracil?

antimetabolites

What is the biggest toxicity risk of 5-flourouracil?

toxic in cats

What kind of chemo is Vinca Alkaloids?

antimicrotubular agents

What is the primary use of Vinca alkaloids (like vincristine)?

multidrug LSA, TVT

What are the toxicities of Vincristine?

ileus, peripheral neuropathy,

What is a substitute for Vincristine?

Vinblastine

Why would you use Vinblastine over Vincristine?

Vinblastine causes no ileus

What Vinca Alkaloid is use for lung tumors and relapsed UCC>

Vinorelbine

What kind of chemo is carboplatin?

platinum agents

What is the primary use of carboplatin?

everything

What kind of chemo is cisplatin?

platinum agents

Why do you not give cisplatin to cats?

fatal pulmonary vasculitis and edema

What kind fo chemo is Toceranib?

tyrosine kinase inhibitors

What are the toxicity risks of toceranib?

GI issues

What drug has a contraindication in west highland white terriers?

tanovea

What is the MOA of tanovea?

nucleotide analog used for the treatment of lymphoma in dogs

What is PNS?

alteration in structure and/or function that occur distant to tumor

What is the general principle to treating PNS?

treat the primary tumor first!

define cancer cachexia

weight loss despite adequate nutritional intake

define anorexia

gastro abnormalities due to poor nutritional intake

How can you approach cancer cachexia?

calculate RER, smaller frequent meals

How can you approach cancer anorexia?

supportive medications for anti-emetics, gastroprotectants, and appetite stimulants. Highly palatable diet, feeding tube